Rationale: Cohort evidence linking long-term exposure to outdoor particulate air pollution and mortality has come largely from the United States. There is relatively little evidence from nationally representative cohorts in other countries. Objectives: To investigate the relationship between long-term exposure to a range of pollutants and causes of death in a national English cohort. Methods: A total of 835,607 patients aged 40-89 years registered with 205 general practices were followed from [2003][2004][2005][2006][2007]. Annual average concentrations in 2002 for particulate matter with a median aerodynamic diameter less than 10 (PM 10 ) and less than 2.5 mm (PM 2.5 ), nitrogen dioxide (NO 2 ), ozone, and sulfur dioxide (SO 2 ) at 1 km 2 resolution, estimated from emission-based models, were linked to residential postcode. Deaths (n ¼ 83,103) were ascertained from linkage to death certificates, and hazard ratios (HRs) for all-and cause-specific mortality for pollutants were estimated for interquartile pollutant changes from Cox models adjusting for age, sex, smoking, body mass index, and area-level socioeconomic status markers.
Measurements and Main Results:Residential concentrations of all pollutants except ozone were positively associated with all-cause mortality (HR, 1.02, 1.03, and 1.04 for PM 2.5 , NO 2 , and SO 2 , respectively). Associations for PM 2.5 , NO 2 , and SO 2 were larger for respiratory deaths (HR, 1.09 each) and lung cancer (HR, 1.02, 1.06, and 1.05) but nearer unity for cardiovascular deaths (1.00, 1.00, and 1.04). Conclusions: These results strengthen the evidence linking long-term ambient air pollution exposure to increased all-cause mortality. However, the stronger associations with respiratory mortality are not consistent with most US studies in which associations with cardiovascular causes of death tend to predominate.